Business Systems Analyst Sr

Amerihealth Caritas•Edgmont Township, PA

9d•Hybrid

About The Position

The Business Systems Analyst Senior – Data will provide techno-functional subject matter expertise for healthcare payor data initiatives, including claims, membership, provider, clinical, care management, interoperability, and population health data domains. This role will lead requirements definition, data analysis, functional specifications, source-to-target mapping, data quality validation, and cross-functional delivery across data Lakehouse and cloud data platforms. This is a hybrid, office based position working in our Ellis Preserve office located in Newtown Square, PA Office days are Tuesday, Wednesday, & Thursday; Remote days and Monday & Friday For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Requirements

At least eight (8)+ years of experience in business systems analysis, data analysis, project delivery, process re-engineering, or related business/technology roles; healthcare payor experience strongly preferred
At least five (5)+ years of experience in healthcare, preferably Medicaid, Medicare, managed care, payer operations, or healthcare data platforms
Strong SQL skills with the ability to create, interpret, and validate complex queries for data analysis, profiling, reconciliation, and business rule validation
Experience with data platforms such as Azure Databricks, Delta Lake, Delta Live Tables, Unity Catalog, Azure Data Factory, Snowflake, Oracle, Informatica, IBM DataStage, Kafka, Pyper, or Python
Knowledge of data governance, data quality frameworks, PII compliance, HIPAA, privacy standards, and data standardization practices
Experience with healthcare payor systems and datasets such as FACETS, claims, membership, provider, clinical, EDI transactions, care management, population health, HEDIS, CMS interoperability, or related payer data domains
Bachelor’s degree in computer science or equivalent years of relevant work experience
Possesses advanced expertise and knowledge of work processes for assigned business areas, including how systems are used, how information flows, how decisions are made, future roadmaps, and how systems may need to adapt to business changes
Demonstrates strong analytical, communication, facilitation, leadership, and stakeholder management skills, with the ability to work independently, manage multiple priorities, resolve competing needs, and guide junior team members
Possesses strong knowledge of business processes, products, and services across business units and how technology supports decision-making across the organization
Understands the business impact of different solutions and can assess and communicate tradeoffs between business needs, technology requirements, costs, and risk
Possesses an understanding of the general competitive landscape from a business and technology perspective

Nice To Haves

Experience in healthcare administration or a healthcare environment preferred

Responsibilities

Provides ongoing support for an assigned set of systems, technologies, and capabilities, including data mapping, configuration, and queries. May serve as a SME for all or most components of a major system, understanding how information is used and how systems may need to adapt to changes in business processes
Leads the requirements management process for change requests, enhancements, and projects, including documenting requirements and changes such as user stories, as appropriate
Leads data-focused requirements management across the SDLC and Agile lifecycle, including intake, estimation, design, development support, testing, deployment, and change management
Provides production support for internally developed and vendor-developed applications, including researching issues, conducting root cause analysis, and performing gap analysis, typically for issues escalated from more junior team members
Acts as a liaison between the business and IS technical solutions/support groups, leading the definition of functional requirements, explaining changes to business processes, and communicating status. Serves as an expert advisor to the IS team to ensure delivery meets business needs
Researches various information and data sources and presents complex information, data, and recommendations to leadership
Creates and maintains functional specifications, source-to-target mappings, traceability documentation, business process maps, and other standard project deliverables such as RTM and FMEA, as applicable
Performs advanced SQL-based data analysis, profiling, validation, and root cause analysis across healthcare payor datasets, including claims, membership, provider, clinical, EDI, and care management data
Partners with data engineering, architecture, governance, business, and reporting teams to support end-to-end data delivery using platforms and tools such as Azure Data Factory, Databricks, Snowflake, Oracle, SQL, and BI/reporting tools
Establishes and monitors data quality SLAs, metrics, dashboards, and issue-resolution processes for business-critical datasets in partnership with data governance and business stakeholders
Validates reporting-layer and analytics outputs by collaborating with Power BI, Tableau, data science, and analytics teams to ensure data accuracy, completeness, consistency, and business usability
Provides guidance and technical knowledge to more junior team members